When Bobby Buka, MD, opened his own practice two years ago in New York, he wanted to find a way to cut the amount of time his former dermatology practice put in calling patients to confirm and remind them of appointments.

Because so many people have cell phones with text-messaging capabilities, Dr. Buka decided texting was the way to go. He said his new staff is saving numerous hours per week by using a text-messaging system that automatically sends the reminders.

While many who have given the systems a try say it's something they now couldn't live without, it takes some groundwork to make sure texting is effective for your practice.

To get started, experts say, practices should first determine what the system will be used for, which will help make easier the decision on which system to buy. Next, the practice should draft the outgoing messages that will be sent and have them cleared by the practice's attorney for possible HIPAA security rule violations. Finally, patients need to be given the option of whether to use the communication mode.

Barry Greene, president and CEO of Med Practice Informatics, a Norwalk, Conn.-based health information technology consulting firm, said on average, practices can reduce staff time from one hour, per doctor, per day to less than 10 minutes by using text messaging systems for appointment reminders, lab calls and follow-ups. He estimated that savings, plus increased revenue by filling saved time with additional patient visits, could boost the bottom line by even $100,000 per year.

There are many Web-based text messaging options. Most are free to set up, with users billed a set fee for the month, generally in the $200 range. Also available are physician-specific systems that can mine data from a practice management or electronic medical records system, which means the messaging is all done automatically. For other systems, cell phone numbers would need to be entered manually each day.

Greene said that many practices already collect cell phone numbers and if they don't, they should start.

For physicians just getting started it might be a slow process before the system reaches its fullest potential, as it might take several months for the databases to be populated with cell numbers.

An example of cost savings

Kaiser Permanente, which recently completed a six-month text messaging pilot program in San Diego, found that practices need to be vigilant about making sure data fields are updated regularly to avoid invalid numbers or bounced-back messages.

During its pilot, 3.4% of messages were bounced back, and 63.86% were never sent, due to invalid records. Kaiser used existing patient rosters when the pilot was launched.

Kaiser conducted its pilot program to determine if texting was an acceptable form of communication and to determine what types of messages patients were interested in receiving. Its system sent out appointment reminders along with "outreach" messages reminding patients of needed mammograms, Pap smears and cardiovascular disease lab tests.

According to Nardo N. Manaloto , manager of solution consulting, analysis and design for Kaiser's southern California business information office, the opt-out rate for appointment reminders during the pilot was low at 1.2%. In the first month, no-shows dropped by 0.7%, or 1,837 visits, for a total savings of $275,500.

Kaiser had no way of knowing the exact influence texting had on the no-show rates compared to other influences. Manaloto said assuming the texting service influenced no-shows by only 5%, that would still be a savings of $13,777.

The number of patients who opted out of the text reminders for Pap smears and mammograms was a little higher than the opt-out rate for appointment reminders at 2.9% and 3%, respectively. The opt-out rates for CVD lab reminders was 2.5%.

Experts say that not only should practices tell patients at the time cell phone numbers are collected how they will be used, but also each text message should include instructions on how to opt out of receiving them.

In Kaiser's case, each message ended with, "Txt STOP to end msgs."

But it learned that still might have been confusing for seniors, whose opt-out rate was actually lower than other age ranges. Kaiser believed that was likely due to older patients not understanding the opt-out process.

Text messaging systems can be set up to only send out, or they can be a two-way system. But as Dr. Buka learned, if you have a two-way system, the staff must be equipped to deal with the return messages. Dr. Buka's system allows patients to respond to the text message to confirm appointments, for example. The messages are sent back as an e-mail that his staff must receive. Then, the staff manually enters any schedule changes or confirmations into the practice management system.

Manaloto said one of the biggest obstacles for Kaiser was combing through regulations and laws pertaining to text messaging. Its legal counsel concurred that the use of text messaging is permissible on the same basis that telephone messages have been permissible under current law.

Greene said that to further protect yourself, the less specific the messages, the better. Messages about test results, for example, could say something like, "Everything looks normal," or in the case of a positive result, "UR lab results are in. Call 2 discuss."

Dr. Buka said he was somewhat surprised at how receptive his patients were to texting. A few months ago, he started using the system to send birthday greetings to his patients. He figured his patients might find it too intrusive. But "the patients love it," he said.